This study assessed the efficacy of combining blood eosinophil (EOS) thresholds and Rome classification to guide corticosteroid therapy in hospitalized acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients. This multicenter study analyzed data from 7 to 111 AECOPD patients, stratified by EOS counts ( 300 cells/μL) and Rome classification severity. Propensity score matching (PSM) was used to balance baseline characteristics between corticosteroid-treated and non-corticosteroid groups. Primary outcomes included 30-day in-hospital mortality, while secondary outcomes encompassed ICU admission, and mechanical ventilation use. Corticosteroid therapy did not significantly reduce short-term mortality but increased the need for non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) in patients with low EOS counts ( 300 cells/μL) and severe disease showed no significant differences in clinical outcomes (P > 0.05). The corticosteroid-treated group exhibited higher rates of hypertension (35.6% vs. 33.0%; P = 0.04), respiratory failure (49.0% vs. 44.6%; P = 0.001) and cor pulmonale (29.0% vs. 24.1%; P < 0.001) but lower rates of osteoporosis (2.1% vs. 3.1%; P = 0.015) and venous thromboembolism (VTE) (4.8% vs. 6.0%; P = 0.041). This multicenter study reveals that systemic corticosteroid therapy does not significantly reduce 30-day in-hospital mortality among AECOPD patients but was associated with increased use of NIV and IMV, particularly in those with EOS counts < 300 cells/μL and mild to moderate disease severity. Future research should focus on identifying subgroups benefiting from corticosteroids and exploring alternative treatments for others at risk. Trial registration: Chinese clinical trial registry, ChiCTR2100044625. URL:http://www.chictr.org.cn/showproj.aspx?proj=121626; date of Registration: 24 Mar 2021.
Pu et al. (Sun,) studied this question.